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ObjectivePeriprosthetic joint infections （PJI） are currently the most calamitous complication after arthroplasty. Although achievements have been made in many markers for the diagnosis of PJI， the lack of a gold standard remains a great obstacle for early diagnosis. This study aimed to investigate the association between coagulation markers and the development of PJI in patients undergoing revision total joint arthroplasty （TJA）. MethodsWe conducted a retrospective cohort study with a total of 2 517 patients who underwent hip or knee arthroplasties from January 2011 to January 2022 （2 394 with primary TJA， 87 with aseptic revision and 36 with PJI）. We applied univariate analysis and multivariate logistic regression to analyze differences of coagulation factors between primary TJA and aseptic revision or PJI group. Receiver operating characteristic （ROC） curve and area under the curve （AUC） were used to measure the diagnostic value of coagulation factors in predicting PJI. ResultsCoagulation factors and their ratios including plasma fibrinogen （FBG）， prothrombin time （PT）， thrombin time （TT）， activated partial thromboplastin time （APTT）， platelet （PLT）， mean platelet volume （MPV）， platelet distribution width （PDW）， plateletcrit （PCT）， PLT / MPV， PLT / PDW and PLT / PCT were included in this study. High FGB level was strongly correlated with the risk of PJI compared to other coagulation factors. The optimal threshold value of FBG was 4.53 g/L with a sensitivity of 47.22%， a specificity of 93.07% （Primary TJA group vs. PJI group）. Similarly， the optimal threshold value of FBG was 4.44 g/L with a sensitivity of 47.22%， a specificity of 95.40% between the other two groups （Aseptic revision group vs. PJI group）. ROC curve analysis demonstrated moderate diagnostic performance of FBG （AUC value）， indicating a potential to be a diagnostic marker for PJI. ConclusionsFBG is significantly correlated with PJI and it can be used as a potential non-invasive marker for early detection. It may serve as a safe and cost-effective tool for assessing PJI in clinical work.
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Periprosthetic joint infection （PJI） following joint arthroplasty is devastating and technique-demanding. At present， the surgical treatment for PJI includes debridement， antibiotics， and implant retention （DAIR）， single- or two-stage revision， arthrodesis， and amputation. DAIR is appealing to both surgeons and patients as it can avoid unnecessary implants removal， making it less time-consuming and less invasive. In this article， we review the current knowledge in surgical timing， intraoperative details and antibiotics strategy of DAIR.
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Periprosthetic joint infection (PJI) is the most difficult complication following total joint arthroplasty. Most of the etiological strains, accounting for over 98% of PJI, are bacterial species, with Staphylococcusaureus and Coagulase-negative staphylococci present in between 50% and 60% of all PJIs. Fungi, though rare, can also cause PJI in 1%-2% of cases and can be challenging to manage. The management of this uncommon but complex condition is challenging due to the absence of a consistent algorithm. Diagnosis of fungal PJI is difficult as isolation of the organisms by traditional culture may take a long time, and some of the culture-negative PJI can be caused by fungal organisms. In recent years, the introduction of next-generation sequencing has provided opportunity for isolation of the infective organisms in culture-negative PJI cases. The suggested treatment is based on consensus and includes operative and non-operative measures. Two-stage revision surgery is the most reliable surgical option for chronic PJI caused by fungi. Pharmacological therapy with antifungal agents is required for a long period of time with antibiotics and included to cover superinfections with bacterial species. The aim of this review article is to report the most up-to-date information on the diagnosis and treatment of fungal PJI with the intention of providing clear guidance to clinicians, researchers and surgeons.
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Humans , Arthritis, Infectious/etiology , Arthroplasty, Replacement, Knee/adverse effects , Fungi , Prosthesis-Related Infections/therapy , Retrospective StudiesABSTRACT
Periprosthetic joint infection (PJI) is a catastrophic complication after artificial joint replacement, and its diagnosis and treatment has always been a great challenge in the field of orthopedics. At present, the treatment strategies for PJI include suppressive antibiotic therapy, debridement antibiotics irrigation of the retained, prosthesis, one-stage revision, two-stage revision, arthrodesis, amputation, and biotherapy, etc. Conventional treatment can not achieve satisfactory results. As a new treatment mode, biotherapy has unique advantages in PJI treatment. This article reviews the risk factors and the source of infection, diagnosis, classification and treatment strategies of PJI, in order to provide valuable reference for clinical treatment of PJI.
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BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection. OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection. METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94% and 86.13%, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection.
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BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection. OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection. METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94％ and 86.13％, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection.
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Objective: To explore the value of three phase bone scintigraphy (TPBS) in diagnosis of periprosthetic joint infection (PJI) after artificial joint replacement (AJR). Methods: TPBS data of 236 patients with 324 joints after AJR were retrospectively analyzed, including 120 joints (48 hips, 72 knees) in PJI group, 119 joints (75 hips, 44 knees) in aseptic loosening group and 85 joints (28 hips, 57 knees) in control group. The uptake of imaging agent around prosthesis was analyzed with visual and semi-quantitative methods. The diagnostic values of different visual judgment criteria for PJI were evaluated according to final clinical diagnosis, and blood pool phases were compared among different groups with semi-quantitative analysis to obtain the best diagnostic threshold and evaluate the diagnostic efficiency. Results: The accuracy rate of abnormal uptake in diagnosis of hip joint infection was higher than that of knee joint infection (92.68% vs 65.51%, P0.05). TBR of knee joint in PJI group was higher than that in aseptic loosening group and control group (both P<0.001), and in aseptic loosening group was higher than in control group (P<0.001). Taken TBR≥1.44 as the threshold, the diagnostic accuracy for PJI of knee joint was 91.38%. Conclusion: TPBS could be used to diagnose PJI after AJR. The visual judgment of TPBS had high accuracy in diagnosis of hip prosthesis infection, whereas combining with semi-quantitative analysis was necessary for judging knee prosthesis infection.
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Objective@#To investigate the clinical effect of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection.@*Methods@#A retrospective analysis of 11 patients(4 hips, 7 knees) admitted with chronic periprosthetic fungal infection at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2004 to April 2016.There were males and females with an age of 67 years (range:47-77 years). Each patient underwent single-stage revision including aggressive soft-tissue debridement. Liquid samples and tissue samples were immediately sent to the microbiology laboratory for drug sensitivity testing and histological analysis. Removed the infected components and cement thoroughly, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungussensitive antibiotics. The patients with infected hips received an uncemented prosthesis and 0.5 g of gentamicin loaded commercial cement was received by the patients with infected knee.After that, a new prosthesis was implanted.Long-term combination therapy of antibacterial agents and antifungal agents were given after operation. Recurrence of infection and clinical outcomes were evaluated. The follow-up period was 5 years (range: 2-12 years).@*Results@#One patient died of acute heart failure on the eighth postoperative day.Three infection cases were recurred.Eight cases had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score assessed preoperatively and at latest follow-up was increased from 39.25±5.12 to 79.50±4.79, the difference was statistically significant (t=-11.356, P=0.001).The Hospital for Special Surgery knee score was improved from preoperative 46.25±5.61 to final follow-up 80.50±5.06, and the difference was statistically significant (t=-9.930, P=0.002).@*Conclusion@#Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes.
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Periprosthetic joint infection (PJI) as an insurmountable challenge has always represented a serious concern for orthopedic surgeons. Accurate diagnosis and reasonable treatment of PJI are the keys to deal with this challenge.The diagnosis of PJI is mainly based on clinical manifestations, joint fluid biochemistry, pathogen culture and biomarkers at present. New pathogen culture methods and specific biomarkers in recent years are hot topics in PJI research. In terms of treatment, two-stage revision is still considered to be the 'gold standard’ protocol. However, more and more centers around the world have begun to accept and try one-stage revision as a treatment for PJI.
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Objective: To compare the effectiveness of the intermittent suture and the cosmetic suture in total knee arthroplasty (TKA). Methods: A clinical data of 48 patients with knee osteoarthritis, who underwent initial TKA between January 2017 and April 2018, was retrospectively analyzed. Among them, 23 patients underwent intermittent suture (group A) and 25 patients underwent cosmetic suture (group B). There was no significant difference in gender, age, body mass index, disease duration, degrees of varus and valgus deformities, knee society score (KSS), visual analogue scale (VAS) score, and levels of interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in serum before operation between the two groups ( P>0.05). KSS scores at 1 and 6 months after operation were used to assess the knee function. VAS scores at 1, 3, and 5 days after operation were used to assess the pain degree of knee. Levels of IL-6, PCT, CRP, and ESR in serum at 1 day and 1 month after operation were recorded to evaluate the risk of periprosthetic infection. Likert score at 6 months after operation was used to evaluate the satisfaction of incision. The hospitalization time after operation was also recorded. Results: All patients were followed up 7- 17 months (mean, 11.3 months). There was no significant difference in hospitalization time after operation between two groups ( t=-1.907, P=0.063). The Likert score in group A was significantly lower than that in group B ( t=-2.196, P=0.033). The VAS score, KSS clinical score and KSS functional score at different time points after operation were significantly better than those before operation in two groups ( P0.05). There was no significant difference in the levels of IL-6, PCT, CRP, and ESR between the two groups at different time points after operation ( P>0.05). Conclusion: Cosmetic suture is superior to intermittent suture in incision appearance and pain management, but there is no significant difference in short-term joint function and risk of periprosthetic infection after TKA.
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OBJECTIVE： To explore the role of clinical pharmacist in individualized treatment for osteosarcoma patients with periprosthetic joint infection （PJI）. METHODS： An osteosarcoma patient was admitted to our hospital and then suffered from PJI after operation. Clinical pharmacist adjusted the initial anti-infection plan and carried out pharmaceutical care according to the results of patients’ etiology and drug sensitivity. According to the PK-PD principle， combined with the therapeutic drug monitoring （TDM）， the dose of antibiotics was adjusted. With the occurrence of ADR， the antibiotic therapeutic regimen was adjusted again. RESULTS： The patient was administrated cefotiam for empiric therapy initially after the diagnosis of PJI. After obtaining the results of etiology and drug sensitivity， the clinical pharmacist suggested that vancomycin sensitive to penicillin-resistant Staphylococcus epidermidis should be used for targeted anti-infection treatment. After adjusting the dosage according to the steady-state valley concentration， the patient had slight liver function damage， accompanied with chest tightness and shortness of breath. After analysis， the clinical pharmacist considered the adverse drug reactions related to vancomycin， and again suggested that the patient should be treated with teicoplanin. After the doctor adopted the treatment plan recommended by the clinical pharmacist， PJI of the patient was effectively controlled， and the adverse reaction symptoms disappeared. The patient was effectively cured for PJI and discharged eventually. During the treatment period， the clinical pharmacist also carried out medication education for the drugs used by the patient. CONCLUSIONS： Clinical pharmacist should master the principle of antibiotic drug PK-PD theory and evaluate the clinical efficacy and safety of anti-infective drugs dynamically based on the guidance of TDM， so as to develop individualized anti-infection therapeutic regimen for osteosarcoma patient with PJI， improve the effect of clinical treatment and guarantee the safety of drug use.
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Periprosthetic joint infection ( PJI), defined as infection involving the joint prosthesis and adjacent tissue, is one of the most serious complications associated with joint arthroplasty.Its accurate diagnosis is still a challenge confronted by arthroplasty surgeons.In this article, we summarize the latest progress on the serological , synovial fluid, microbiologic, histopathological and radiological diagnosis of PJI to provide new concepts for arthroplasty surgeons.
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Periprosthetic joint infections are a major cause of morbidity and mortality following total joint arthroplasty. Two-stage arthroplasty, with the use of an antibiotic cement spacer, is an effective means of managing periperiprosthetic joint infections. There is a lack of data relating to the management, prognosis, and clinical outcomes associated with multiple peri-prosthetic joint infections. Here, we present a case report of a patient successfully treated for three synchronic peri-prosthetic joint infections of both knees and a single hip.
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Humans , Arthroplasty , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Hip , Joints , Knee , Mortality , PrognosisABSTRACT
BACKGROUND: The purpose of this study was to evaluate the usefulness of sonication technique for microbiological diagnosis and the sterility of the recycled autoclaved femoral components from infected total knee arthroplasty (TKA) using a sonication method. METHODS: Nineteen femoral implants explanted from patients with infected TKA were sterilized with a standard autoclave method. Standard culture of the fluid before and after sonication of the sterilized implants was performed to detect pathogenic microorganisms. Additional experiments were performed to evaluate the sterility of the recycled implant by inducing artificial biofilm formation. Methicillin-resistant Staphylococcus aureus (MRSA) was inoculated into 10 implants and sterilization in a standard autoclave was performed, and then the fluid was cultured before and after sonication. RESULTS: Two of the 19 sterilized implants were positive for growth of bacteria after sonication, whereas no growth was detected in the cultured fluid from the sterilized implants before sonication. The bacteria were Staphylococcus species in all two cases. In one of 10 implants inoculated with MRSA, the culture was positive for growth of bacteria both before and after sonication. However, Staphylococcus epidermidis was cultured from both occasions and thus this implant was thought to be contaminated. CONCLUSIONS: We found sonication for identification of pathogens could be helpful, but this finding should be interpreted carefully because of the possibility of contamination. Sterilization of an infected femoral implant with an autoclave method could be a good method for using the temporary articulating antibiotic spacer in two-stage revision arthroplasty.
Subject(s)
Humans , Arthroplasty , Arthroplasty, Replacement, Knee , Bacteria , Biofilms , Diagnosis , Infertility , Methicillin-Resistant Staphylococcus aureus , Methods , Sonication , Staphylococcus , Staphylococcus epidermidis , SterilizationABSTRACT
Objective The dynamic detection of endotoxin is of great significance for the early diagnosis and treatment of prosthesis loosening after joint replacement. This study aimed to explore and analyze the clinical significance and efficacy of endotoxin detection in prosthetic joint loosening after joint replacement.Methods Fifty-eight patients who underwent arthroplasty in the department of orthopedics in Nanjing General Hospital from January 2015 to June 2016 were selected for prospective study. The patients were divided into the infection loosening group (patients with infectious loosening after arthroplasty, n=15), the aseptic loosening group (patients with aseptic loosening of after arthroplasty, n=23) and the control group (patients were normal after arthroplasty, n=20) according to the postoperative complications. Endotoxin was detected with MB-80 microbial dynamic rapid detection system. We compared the endotoxin level and the ROC curve was made to acquire the sensitivity and specificity under the different cut-off values. Eventually find the best diagnostic threshold.Results The levels of endotoxin in the infection loosening group and the aseptic loosening group \[(0.56±0.11, 0.49±0.08) ng/mL\] were significantly higher than that in the control group \[(0.24±0.06) ng/mL\]. The difference was statistically significant (P0.05). ROC curve analysis showed that when the serum endotoxin concentration was 0.36 ng/mL, the Youden index was the highest, which could be the best cut-off value for diagnosis. It had the best accuracy to judge the prosthesis loosening with a sensitivity of 66.7% and specificity of 88.2%.Conclusion The endotoxin can be a good indicator for early diagnosis of prosthesis looseness. It is helpful to the diagnosis of the prosthesis loosening after arthroplasty.
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Objective To explore the possible application of suPAR in the early diagnosis of periprosthet-ic joint infection(PJI). Methods A total of 53 patients with PJI who underwent total arthroplasty were selected as the PJI group. According to ratio of 1:2 between hospital and community,60 people were selected as the control group. The level of suPAR,CRP,IL-1,IL-6,TNF-α and IL-12 were measured. ROC curves were drawn to calcu-late the AUCs of these indicators. Results The level of serum suPAR in PJI patients was(6.70 ± 0.24)ng/mL, which was significantly higher than that in the control group(1.76 ± 0.11)ng/mL,and the difference was statisti-cally significant(P < 0.05). The level of serum IL-12 in PJI patients was(41.99 ± 4.02)pg/mL,which was signifi-cantly higher than that in the control group(23.57 ± 3.16)pg/mL,and the difference was statistically significant (P < 0.05). There was a positive correlation between suPAR and CRP,IL-6,TNF-α and IL-12,and their correlation coefficientwere 0.752,0.769,0.842,0.760 and 0.767,respectively. In addition,the area under the ROC curve of PJI was 0.888,while the AUC of CRP and IL-6 were 0.763 and 0.833,respectively. Conclusion Serum suPAR has a high diagnostic potential in the diagnosis of PJI and can be used as a potential diagnostic marker for PJI.
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Periprosthetic joint infection (PJI) due to Salmonella is rare. It frequently occurs patients receiving immunosuppressive medicine. We describe two periprosthetic Salmonella infection of two immunocompromised patients. Both of patients were receiving azathioprine and prednisolone therapy. First patient presented six years after total hip arthroplasty with a huge abscess on her right thigh that was reached to femoral component through the lytic area of lateral femur. Second patient presented with drainage from his hip and he had undergone two-step revision surgery for PJI 3 months ago. There is no consensus in the treatment of periprosthetic salmonella infections. We prefer two-step revision surgery for these infections as previously described in the literature.
Subject(s)
Humans , Abscess , Arthroplasty, Replacement, Hip , Azathioprine , Consensus , Drainage , Femur , Hip , Immunocompromised Host , Joints , Prednisolone , Salmonella Infections , Salmonella , ThighABSTRACT
PURPOSE: Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a grave complication. Urinary tract infection (UTI) as a source for PJI is controversial. Our purposes were, (1) to evaluate the incidence of PJI after elective primary THA and (2) to determine whether UTI was associated with a risk of PJI after elective primary THA. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 527 patients who underwent elective primary THA by using universal aseptic technique from May 2003 to October 2007. UTI group (13 patients) was defined as patients who underwent THA in status of having an UTI, and the remaining patients were defined as control group (514 patients). We compared the incidence of PJI in both groups. RESULTS: During the study period, the incidence of PJI was 0%, regardless of existence (or presence) of UTI. CONCLUSION: There was no significant association between UTI and PJI, when cautiously performed THA.
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Humans , Arthroplasty , Arthroplasty, Replacement, Hip , Hip , Incidence , Joints , Medical Records , Retrospective Studies , Urinary Tract Infections , Urinary TractABSTRACT
Periprosthetic joint infection (PJI) of the hip can be difficult to treat and can lead to a number of problems including: i) severe functional decline of the hip joint and ii) increasing financial burden for patients due to long treatment periods and the need for repeated surgical interventions. Because there is risk of inadequate control of infection or relapse of a preexisting infection following the treatment of PJI through surgery, it is important to closely observe clinical symptoms such as systemic fever. Kikuchi-Fujimoto disease is usually a self-limiting disease characterized by fever and cervical lymphadenopathy. We report one case of Kikuchi-Fujimoto disease, with literatures review, that was mistaken for an infection relapse after surgical treatment of the PJI due to sustained fever postoperatively.
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Humans , Fever , Hip Joint , Hip , Histiocytic Necrotizing Lymphadenitis , Joints , Lymphatic Diseases , RecurrenceABSTRACT
As one of the most catastrophic complications, prosthetic joint infection remains one of the most stubborn medical problems.However, the biomarkers and laboratory tests commonly used often exhibit either a low sensitivity or a low specificity, which makes it still difficult to diagnose.Therefore, we summarize a number of recent new developments home and abroad, and overview from the aspects of serological markers, synovial fluid markers, radionuclide imaging methods, preoperative periprosthetic tissue biopsy, in-traoperative periprosthetic tissue culture, histological analysis of periprosthetic tissue and new molecular technology.